Provider Demographics
NPI:1528419462
Name:DEVERICKS, TELISHIA (DC)
Entity Type:Individual
Prefix:DR
First Name:TELISHIA
Middle Name:
Last Name:DEVERICKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 E 57TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8705
Mailing Address - Country:US
Mailing Address - Phone:605-636-5013
Mailing Address - Fax:
Practice Address - Street 1:4900 E 57TH ST STE B
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8705
Practice Address - Country:US
Practice Address - Phone:605-636-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor